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PubMed2001

[Therapeutic plasma exchange with particular regard to the perioperative period].

The end of the last decade of the XXth century caused that therapeutic plasma exchanges have found an important place in the therapeutic management of many pathological conditions. This was possible owing to the knowledge of the pathophysiology of many diseases and pathological factors present in circulation. Therapeutic plasma exchange is the procedure during which pathological substances are removed from patient's circulation without causing anaemia and oncotic pressure disturbances. The procedures are carried out in order to eliminate pathological components of the plasma. Therefore, the general indication to plasma exchange are disease entities, the pathogenesis of which depends on plasma composition abnormalities. The understanding of the mechanisms of action of therapeutic plasma exchange, pathogenesis of certain diseases, and results of controlled studies of procedure effectiveness made possible to establish the indications to the procedure. In view of varying indications to therapeutic plasma exchange, in the paper these indications are discussed which are of importance in perioperative period. In clinical practice, therapeutic plasma exchange in myasthenia gravis has been applied, among other, in acute states in order to stabilize patient's condition after thymectomy or during preparation for thymectomy. The resistance occurring to preparations of blood-clotting factors is the cause of their ineffectiveness in control of bleeding. Application of plasma exchange and removal of antibodies make possible to achieve sensitivity of patient's organisms to exogenous blood-clotting factors. Good effects were observed in the treatment of hepatic coma in which application of the procedures frequently enables survival until performing transplantation. Therapeutic plasma exchange is the method of symptomatic treatment. The procedures may enable or facilitate management of patients in preoperative or postoperative periods but they cannot cause permanent cure.

Humans↗

PubMed2003

The effects of various therapeutic measures on shoulder range of motion and cross-sectional areas of rotator cuff muscles after baseball pitching.

AIM: The purpose of this study was to investigate the effects of various therapeutic measures on the shoulder range of motion (ROM) and muscle cross-sectional area (mCSA) of rotator cuff muscles after baseball pitching. METHODS EXPERIMENTAL DESIGN: a mode of therapeutic measures was classified in 4 groups; the control (CON), ice treatment (IT), light shoulder exercise (LSE) and ice treatment with LSE (ILSE) groups. Each therapeutic measure was performed after pitching. PARTICIPANTS: 7 healthy, skilled baseball pitchers. MEASURES: ROM and mCSA were measured before pitching, immediately after pitching, at the time of the therapeutic measure, and 24 hours after pitching. Shoulder ROM at 90 inverted exclamation mark of abduction included internal rotation (IROM), maximum internal rotation (IMROM), external rotation (EROM) and maximum external rotation (EMROM). RESULTS: In all groups, both IROM and IMROM were significantly decreased after pitching compared with the pre-exercise values and conversely both EROM and EMROM were significantly increased. The mCSA of all rotator cuff muscles were increased significantly after pitching. For IMROM, ILSE showed a significant recovery at the post-therapeutic measure compared with the others and at 24 hours after pitching compared with IT, respectively. For IROM, both LSE and ILSE showed significant recovery compared with CON at the post-therapeutic measure. For the mCSA of external muscles, ILSE showed a greater decrease at the post-therapeutic measure than the others, and at 24 hours after pitching than CON. CONCLUSION: This study suggested the possibility that ILSE was more effective to recover ROM and decrease mCSA than the other methods.

Adult↗

PubMedDate not supplied

[Therapeutic monitoring of tricyclic antidepressant drugs].

Therapeutic drug monitoring (TDM) is used to optimise therapy by an assessment of the drug's plasma concentration. The indications for TDM according to Preskorn are: 1. well defined relationships between plasma concentration of a drug and its therapeutic efficacy, and between plasma level and adverse events and/or toxicity, 2. narrow therapeutic index of a drug, 3. significant interindividual variability of the dose--plasma concentration relationship, 4. delayed onset of action, 5. difficulty in early diagnosis of toxic events. Tricyclic antidepressants (TCA's) fulfill many criteria for TDM. Interethnic and interindividual differences in pharmacokinetics of TCA's lead to pronounced differences of plasma level. Interindividual variability of plasma concentration of TCA's is connected with age, concomitant diseases, genetically determined polimorphism of cytochrome P-450 enzymes (e.g. CYP2D6) and co-medications (the drug may change pharmacokinetic properties of TCA's). There is no clear relationship between plasma concentration of TCA's and therapeutic efficacy of a drug. Contrary there is clear correlation between plasma level and adverse events (especially cardiotoxic and neurotoxic AE). Therapeutic ranges of plasma concentration for TCA's are well established. In the case of SSRI's or newer antidepressants the clear relationship between plasma level and their therapeutic effect, that is their efficacy and tolerability has not been determined yet. The relationships between plasma concentrations and efficacy and tolerability of TCA's, as well as therapeutic ranges of TCA's and other antidepressants are presented in this paper.

Antidepressive Agents, Tricyclic↗

PubMed2004

Development of computerized guidelines for the management of chronic diseases allowing to position any patient within recommended therapeutic strategies.

Chronic diseases are complex to manage. One reason comes from the difficulty to synchronize a patient's therapeutic history with the guideline-based sequence of treatments. We propose to represent guideline knowledge as a two-level decision tree, a clinical level describing theoretical clinical situations and a therapeutic level formalizing the different steps of corresponding recommended therapeutic strategies. Guideline-based strategies are first represented as bidimensional matrices structured in lines of therapy and levels of therapeutic intention. A revised version introducing levels of therapeutic combination is then developed. The therapeutic level is operationalized for any patient therapeutic history to provide the next best step of treatment. Evaluated on actual patient records, our system proved to impact physicians' decisions in 78% of the cases and led to a significant improvement of their compliance with recommendations.

Chronic Disease↗

PubMed2004

Ex vivo therapeutic index by drug sensitivity assay using fresh human normal and tumor cells.

Toxicity is a major deterrent to achieving substantial improvements in cancer management, since most anticancer drugs inadequately distinguish normal and neoplastic tissues. Improving the differential between beneficial and toxic effects of therapy--therapeutic index--is a major clinical objective, but therapeutic index for cytotoxic drugs is narrow. Fresh tumor and normal cells from 59 patients with acute myeloid leukemia, non-Hodgkin's lymphoma, ovarian cancer and cancers of unknown origin were tested for ex vivo drug sensitivity using apoptosis by morphology assays. Drugs tested included carboplatin, doxorubicin, vincristine, cytarabine, fludarabine, mafosfamide and etoposide. Therapeutic index was derived from the ratio of normal and tumor cell LC90s. Individual patient therapeutic index varied markedly for different drugs and drug therapeutic index varied from patient to patient ranging from extremely unfavourable (<0.001) through excellent (>1000) reflecting patient heterogeneity. Therapeutic index for each drug was consistent with clinical expectations. Significantly, there was no relationship between normal and tumor cell LC90s. We conclude that further laboratory and clinical evaluation is required but the derived ex vivo therapeutic index could enhance choice of chemotherapy by reducing toxicity and/or improving efficacy.

Adolescent↗

PubMed2005

Potent antitumoral effects of a novel gene-viral therapeutic system CNHK300-mEndostatin in hepatocellular carcinoma.

BACKGROUND: The expression of therapeutic gene and its anti-tumor effects will be augmented and a synergism of oncolytic virus with the therapeutic gene is speculated. This study was undertaken to assess the anti-tumor effects of a novel gene-viral therapeutic system CNHK300-mEndostatin (CNHK300-mE) in hepatocellular carcinoma (HCC). METHODS: A novel gene-viral therapeutic system named CNHK300-mE was constructed using the human telomerase reverse transcriptase (hTERT) promoter to drive the expression of the adenovirus E1A gene and cloning the therapeutic gene mouse endostatin into the adenovirus genome. By the tissue culture infectious dose 50 (TCID50) method and cytoviability assay, the replicative and cytolytic capabilities of CNHK300-mE in two HCC lines (HepGII and Hep3B) and one normal cell line (MRC-5) were analyzed, and the transgene expressions of mouse endostatin in vitro and in vivo were detected by Western blotting and ELISA assay. Tumor growth suppression and anti-angiogenesis effects in vivo were investigated using nude mice xenografts model derived from SMMC-7721 HCC cells. RESULTS: The 3296-fold replicating capacity of CNHK300-mE in HCC cell lines versus in the normal cell line at 96 hours post infection and the 25-fold effective dose for killing 50% cells (ED50) in the normal cell line versus HCC cell lines, which were both superior to ONYX-015, were observed. Tumor growth suppression of CNHK300-mE superior to either Ad-mE or ONYX-015 was demonstrated (P < 0.01) and the anti-angiogenic effects in vivo superior to Ad-mE were also observed with immunohistochemical staining of von Willebrand factor. In comparison with non-replicative adenovirus Ad-mE, the transgene expression of mE mediated by CNHK300-mE was significantly higher in vitro (P < 0.005) and in vivo (P < 0.05). CONCLUSION: Being capable of replicating in and lysing the telomerase-positive HCC cells and mediating effective expression of the therapeutic gene in vitro and in vivo, the novel gene-viral therapeutic system CNHK300-mE is potentially effective in the treatment of HCC.

Adenoviridae↗

PubMed2005

De-immunization of therapeutic proteins by T-cell epitope modification.

Many therapeutic proteins in clinical use have been shown to elicit antibody responses which in some cases have been linked to adverse events. Conventional animal models, although convenient, have rarely been predictive of immunogenicity in humans. New methods for predicting the potential immunogenicity of therapeutic proteins are needed. This treatise proposes a new approach which pairs in silico T-cell epitope analysis with in vitro studies. T-cell epitope mapping algorithms such as EpiMatrix can be used to evaluate a candidate therapeutic protein for T-helper epitopes, followed by confirmation of the T-helper epitopes using in vitro methods such as MHC binding assays and T-cell assays. Once these are identified, substitution of key amino acids in the T-cell epitopes may attenuate the immunogenicity of the protein, since modification of the amino acids in anchor position(s) can abrogate binding to human class II MHC molecules and presentation of the peptides, in the context of MHC, to T-helper cells. Following substitution of the key amino acids, immunogenicity of the modified protein can be evaluated in vitro. In parallel, the potential effect of the modifications on the structure of the protein can be evaluated using in silico modeling methods. This multi-step process has been termed DeFT for de-immunization of functional therapeutics. In this article we review the rationale for the approach, provide several retrospective examples that prove the approach in principle, and describe potential applications to therapeutic protein design. The demand for pre-clinical means of evaluating therapeutic proteins is expected to increase with the number of therapeutic proteins and monoclonal antibodies entering the pre-clinical pipeline. Examples provided offer some preliminary proof that the de-immunization approach may improve clinical outcomes.

Animals↗

PubMed2006

[Evaluation on clinical therapeutic effect of needle-knife therapy on cervical spondylosis].

OBJECTIVE: To compare therapeutic effects of needle-knife therapy and acupuncture on cervical spondylosis. METHODS: Multi-central clinical randomized controlled trial was adopted. The patients were divided into a needle-knife treatment group treated with needle-knife therapy at the upper and lower interspinal ligaments of the affected vertebral body and bilateral posterior joint capsules; and the acupuncture control group were treated with acupuncture at Laozhen, Ashi points and cervical Jiaji points, etc. The short-term and the long-term therapeutic effects were observed at the end of the therapeutic course and 6 months after the end of the therapeutic course. RESULTS: The short-term therapeutic effect and the long-term therapeutic effect were 91.3% and 94.7% in the needle-knife treatment group and 59.4% and 56.6% in the acupuncture control group, respectively, with a very significant difference between the two groups (P < 0.01). CONCLUSION: The needle-knife treatment in the therapeutic effect on cervical spondylosis is superior to acupuncture treatment.

Acupuncture Therapy↗

PubMed2006

Therapeutic DNA vaccines against tuberculosis: a promising but arduous task.

OBJECTIVE: To review recent developments in therapeutic DNA vaccines against tuberculosis. DATA SOURCES: The data used in this review were obtained mainly from the studies of therapeutic DNA vaccines against tuberculosis reported from 2000 to 2006. STUDY SELECTION: Relevant articles about studies of therapeutic DNA vaccines against tuberculosis were selected. DATA EXTRACTION: Data were mainly extracted from the 32 articles listed in the reference section of this review. RESULTS: Some DNA vaccines which previously showed to induce protective immunity against infection by Mycobacterium tuberculosis in a prophylactic manner are also surprisingly effective when used therapeutically, including persistent Mycobacterium tuberculosis and multidrug-resistant tuberculosis which are refractory to immune system and antibacterial chemotherapy alone. When used in combination with antibacterial drugs, therapeutic DNA vaccines could effectively eliminate residual bacteria in infected animals and shorten the therapy course of conventional chemotherapy. Detailed studies demonstrated that therapeutic effects of DNA vaccines may at least partly be due to the restoration of the Th(1)/Th(2) balance. Some problems have also emerged along with these exciting results. CONCLUSIONS: Therapeutic DNA vaccine is a promising strategy against tuberculosis, however developing an ideal DNA vaccine for therapy of tuberculosis will require further development.

Humans↗

PubMed2003

[The use of embryonic stem cells for medical-therapeutical purposes: a study of attitudes among Icelandic physicians, lawyers and clergymen.].

OBJECTIVE: To study the bioethical standpoints among three groups of Icelandic professionals in relation to the use of embryonic stem cells for medical-therapeutical purposes. MATERIAL AND METHODS: In June 2002, a questionnaire was sent by mail to a random sample of 284 doctors and 293 lawyers, as well as all 168 practicing clergymen in Iceland. The participants' position in relation to the use of embryonic stem cells for therapeutical purposes was elicited through general questions as well as case examples. 290 questionnaires (39%) were returned. RESULTS: 62% of participants believed the embryo to have an ethical status superior to that of biologically comparable life forms. 20% of respondents considered its status as equal to that of a grown human being, whilst 18% considered it equal to biologically comparable primitive life forms. There was a difference between the respondent groups (p<0,05). A vast majority believed the use of embryonic stem cells for therapeutical purposes to be justifiable, although the origin of the stem cells appeared to make a difference to many respondents. 8% of participants took an unconditional position against the use of embryonic stem cells. Among those who considered the use of embryonic stem cells with a therapeutic aim to be justifiable, 71% believed that embryonic stem cells should only be utilized to treat diseases of a severe nature. 64% of participants defended the idea of therapeutic cloning with the intention to treat a patient with Parkinson's disease, but the case history elicited considerable difference between professional groups. Clergymen and lawyers tended to hold firmer attitudes, clergymen against and lawyers for the use of stem cells, whilst medical doctors as a group positioned themselves more towards the middle. Female respondents generally took a more modest stand whilst males were more likely to take a firmer stand in both directions. A vast majority (87%) of the participants believed there to be a need for public debate in relation to the use of embryonic stem cells for therapeutical purposes. CONCLUSION: Overall, participants views in relation to the use of embryonic stem cells for medical purposes were rather liberal. There were however significant differences between professional groups. The relatively high tolerance in regard to therapeutic cloning is interesting in view of the considerable controversy over this topic in many countries. There appears to be fertile ground for a public debate about the use of embryonic stem cells for medical purposes in Iceland.

English Abstract↗

PubMed1994

New therapeutic agents marketed in 1993.

In 1993, the Food and Drug Administration (FDA) approved 25 new molecular entities (NMEs), 23 of which are for therapeutic use and two are diagnostic agents. Eleven of the NMEs for therapeutic use, as well a new biological agent intended for therapeutic use, were both approved and marketed in the United States in 1993. In addition, 11 other NMEs that the FDA approved before 1993 (most in late 1992) were marketed during the year. Thus, a total of 23 therapeutic agents reached the U.S. market for the first time in 1993, a considerably lower number than the 30 new therapeutic agents marketed in 1992 and the record number 31 new agents marketed in 1991. Many of the 13 therapeutic agents approved in 1993 but not marketed before the end of the year have become available in early 1994. Of the 23 new therapeutic agents first marketed in 1993, 22 are considered in this series. The one agent not reviewed is flosequinan, which was withdrawn from the market after being available only several months because of a concern about toxicity. This review considers the new agents' most important properties and, when possible, compares them with other available agents with similar properties. When additional information is needed, more comprehensive references and the product literature should be consulted.

Adolescent↗

PubMed1994

Large-volume therapeutic amniocentesis in the treatment of hydramnios.

OBJECTIVE: To evaluate the safety and outcome of large-volume therapeutic amniocentesis in the treatment of hydramnios. METHODS: Therapeutic amniocentesis was defined as an attempt to remove enough amniotic fluid (AF) in pregnancies complicated by symptomatic hydramnios to leave a normal volume of AF (AF index less than 25 cm). This report includes all therapeutic amniocenteses that were performed at Good Samaritan Regional Medical Center in Phoenix, Arizona, from 1988-1993. RESULTS: Ninety-four patients had 200 therapeutic amniocenteses. The most common condition treated with therapeutic amniocentesis was twin-twin transfusion syndrome (36 patients). The mean volume of fluid removed was 1666 +/- 1245 mL (mean +/- standard deviation). The median volume of fluid removed was 1500 mL (range 350-10,000). The fluid was removed at a mean rate of 54 +/- 22 mL/minute. Complications were limited to one patient with ruptured membranes one day after therapeutic amniocentesis, one patient who developed chorioamnionitis, and one patient with an anencephalic fetus who had an abruption following removal of 10,200 mL of fluid. CONCLUSION: Large-volume therapeutic amniocentesis can be used to treat hydramnios, with a 1.5% complication rate.

Amniocentesis↗

PubMed1994

New therapeutic agents marketed in 1993.

Drug Approval↗

PubMed1995

A canine model for determination of the therapeutic index of cytokine inhibitors.

Using tumor necrosis factor (TNF) inhibition in dog blood as a measure of efficacy, and canine emesis as a measure of toxicity, we were able to assign a therapeutic index to rolipram, a prototypic anti-inflammatory compound. Because both assays were performed in the same species, the ambiguities associated with comparing the physiologic effects of drugs on various species was avoided. Rolipram, a standard phosphodiesterase type IV inhibitor, was a prototypic test compound characterized by a number of cardiovascular and central nervous system side effects, as well as its in vitro and in vivo inhibition of TNF. Initial experiments with canine whole blood incubated with lipopolysaccharide resulted in nanogram-per-milliliter concentrations of TNF that could be significantly reduced by in vitro addition of a 0.03 microM concentration of rolipram. Because rolipram inhibited canine TNF production in vitro, a protocol was devised in which TNF inhibitory activity was measured in a series of blood samples from dogs infused with increasingly high doses of rolipram. This yielded the efficacy half of the therapeutic index, whereas the emetogenic dose represented the side effect portion of the index. Rolipram was infused stepwise into conscious dogs at gradually increasing doses. The infusion was stopped when vomiting occurred, and the cumulative dose was reported as the emetic dose. Rolipram caused emesis in dogs at a cumulative dose of 0.1 mg/kg. At each dose of rolipram, blood was collected. The whole blood was incubated in vitro with lipopolysaccharide to induce TNF production, which in turn was quantified by the L929 bio-assay. Theoretically, if the rolipram infusion raised blood values high enough, the rolipram in whole blood would inhibit TNF production and be reflected by a lack of TNF activity in the L929 assay. In this assay system, rolipram's 50% effective dose in the TNF assay was always at least 33-fold lower than its emetic dose of 0.1 mg/kg. This gave rolipram a therapeutic index of at least 33:1 (0.003 versus 0.1 mg/kg) on the basis of its activity in a canine efficacy model (TNF inhibition) and a toxicity model (emesis induction). Experimental compounds were tested for their emetic dose as well as TNF 50% effective dose, with the goal of obtaining a therapeutic index better than that of rolipram. Thus the coupling of cytokine activity with overt toxicity was used to arrive at the therapeutic index of a compound. The therapeutic index was used to rank compounds as to their efficacy/toxicity profile. This ranking was used to eliminate several anti-inflammatory compounds that had a therapeutic index less than that of rolipram.

Animals↗

PubMed1996

[Can one be a urologist without being familiar with the methodology of therapeutic trials?].

OBJECTIVE: To define the principles of the methodology applied to therapeutic trials in medicine and surgery. To define methodological aspects related to therapeutic trials in urology. To exhaustively study three urology journals in order to analyse the methodological quality of the articles published. METHODS: The basic principles of therapeutic trials are described: the randomized double-blind placebo-controlled trial is the most valid trial to demonstrate the efficacy of a treatment. In surgery, and especially in urology, these therapeutic trials comparing two surgical techniques must be conducted by teams accepting the ambivalence of comparison after randomization. Ideally, treatment is evaluated by observers blinded to the technique used. The assessment criteria must be as clinical as possible and must be based on universally accepted standardized measurements. The quality of a therapeutic trial is assessed in terms of its protocol, but also on the quality of practical conduct of the trial, the precision and accuracy of its statistical analysis and the presentation of the results. The first 1995 issue of the "Journal of Urology", the "British Journal of Urology" and "Progrès en Urologie" were studied exhaustively, looking for articles dealing with a therapeutic evaluation. The comparative or non-comparative nature of the study, the presence or absence of randomization, double-blind, and a predetermined sample size were noted for each study. RESULTS: Ten non-comparative retrospective studies, one non-comparative prospective study and five trials with a control group, including two open randomized trials were reported in the "Journal of Urology". Nine retrospective non-controlled studies were reported in the "British Journal of Urology". Seven retrospective studies, including one open, non-randomized study with a control group, were reported in "Progrès en Urologie". CONCLUSION: The principles of the methodology of therapeutic trials can be applied to the evaluation of a treatment or a surgical technique, especially in urology. Compliance with the rules of methodology impose additional constraints, sometimes difficult to implement, but essential to ensure the quality of the results obtained. Randomized trials are rare in urological publications, which still largely consist of retrospective non-comparative series.

Clinical Trials as Topic↗

PubMed1989

Experience with a two-tiered therapeutic interchange policy.

A university hospital's formulary policy for therapeutic interchange is described in which pharmacists can routinely interchange some drugs but must contact the prescribers before interchanging other drugs. For drugs that are not automatically interchanged by the pharmacy, the formulary contains a "class representative," which pharmacy may change as relative prices of drug products change. When a non-formulary drug for which there is a designated class representative is prescribed, pharmacy contacts the prescriber. When a class representative for injectable histamine H2-receptor antagonists was being selected, previous positive and negative experiences with establishing therapeutic equivalence for antimicrobial agents were considered. The implementation of H2 antagonist therapeutic equivalence included the following steps: determining potential cost savings, reviewing the literature, consulting with specialty practitioners, presenting the information to the pharmacy and therapeutics committee, distributing formal bids, and educating hospital staff. Before cimetidine was designated the class representative, 84% of orders for injectable H2 antagonists were for ranitidine; one year later, 90% were for cimetidine. Orders for oral H2 antagonists also changed from predominantly ranitidine to predominantly cimetidine. The hospital's total costs for H2 antagonists decreased 8.4% in one year. The two-tiered approach to therapeutic interchange can reduce drug costs and increase the scope of agents deemed therapeutic equivalents in a manner that is acceptable to physicians and pharmacists.

Boston↗

PubMed1979

The therapeutic community as a research ward: myths and facts.

The clinical research ward run as a therapeutic community has been criticized as inefficient and scientifically unsound. This article discusses the therapeutic community as a research ward and identifies certain misconceptions which underlie many criticisms. The following myths are discussed and refuted: (1) There is an insurmountable community-research chasm. (2) The therapeutic community induces stress that interferes with research. (3) Patient passivity is engendered by research and this is destructive to the therapeutic community. (4) Symptoms are exacerbated by a research ward that is disruptive to the community. (5) Normal research subjects cannot live in a therapeutic community without pathologic psychic changes. These inaccurate myths are seen as a reflection of attempts to oversimplify very complex clinical and research issues. The use of mythology to simplify experiments, to artificially "clarify" complex issues, or to "protect" patients is seen as a disservice. The therapeutic community and research are syntonic when both receive appropriate support.

Adult↗

PubMed2005

Balance of risk of therapeutic hypothermia.

The complications of therapeutic hypothermia sometimes undermine its clinical effects. In this study we investigated the efficacy and safety of therapeutic hypothermia based on analysis of 20 severe head injury cases from 6 institutions treated with therapeutic hypothermia in 1999. The twenty patients with severe head injury were enrolled prospectively based on the following indications; Glasgow Coma Scale of 7 or less on admission, age 60 or younger, and systric BP over 100 mmHg. A control group consisting of 21 patients with severe head injury met the same criteria but were treated without therapeutic hypothermia in other institutions. Clinical benefit were evaluated by a comparison of clinical result in the two groups defined according to the Glasgow Outcome Scale six months after injury. The hypothermia group was divided into two groups based on a target temperature [mild hypothermia group: 32-34 degrees C (n = 10); very mild hypothermia group: 35-36 degrees C (n = 10)]. The complication rate, clinical results and the duration of therapeutic hypothermia were analyzed between two groups. In the hypothermia group, 12 patients obtained a favorable outcome (Good Recovery or Moderate Disabled in GOS) and the mortality rate was 35%. In the control group, however only 5 patients had a favorable outcome and the mortality rate was 57%. Comparison between mild hypothermia and very mild hypothermia groups revealed no difference in clinical outcome. In the hypothermia group, severe pneumonia was seen in three patients, all in the mild hypothermia group with a hypothermic duration of over 120 hours. Mild hypothermia should be ended within 120 hours to avoid severe complication. When long-lasting therapeutic hypothermia of more than 120 hours is planned, very mild hypothermia is the treatment of choice.

Adult↗